IMMUNE RESPONSE AND ANAMNESTIC IMMUNE RESPONSE IN CHILDREN AFTER A 3-DOSE PRIMARY HEPATITIS B VACCINATION

Authors

  • Muhammad Faheem Afzal King Edward Medical University, Lahore
  • Muhammad Ashraf Sultan King Edward Medical University, Lahore
  • Ahmad Imran Saleemi King Edward Medical University, Lahore

Abstract

Background: Diseases caused by Hepatitis B virus (HBV) have a worldwide distribution. Pakistan adopted the recommendations of World Health Organization (WHO) for routine universal infant vaccination against hepatitis B in 2002, currently being administered at 6, 10, and 14 weeks of age in a combination vaccine. This study was conducted to determine the immune response & anamnestic immune response in children, 9 months–10 years of age, after a 3-dose primary Hepatitis B vaccination. Methods: This cross sectional study was conducted in the Department of Paediatrics, King Edward Medical University/Mayo Hospital, Lahore, Pakistan, from January to June, 2014. A total of 200 children of either sex between the ages of 9 months to 10 years, docu­mented to have received 3 doses of hepatitis B vaccines according to Expanded Program of Immunization (6,10,14 weeks) schedule in infancy, were recruited by consecutive sampling. The level of serum anti-HBsAb by ELIZA was measured. Children with anti-HBs titers ≥10 mIU/mL were considered to be immune. Those with anti-HBsAb levels <10 mIU/mL were offered a booster dose of infant recombinant hepatitis B vaccine. The second serum sample was obtained 21–28 days following the administration of the booster dose and the anamnestic immune response was measured. Data was analysed using SPSS 17 to determine the relation between time interval since last vaccination and antibody titer. Chi square test was applied. Results: Of the 200 children, protective antibody response was found in 58%. Median serological response was 18.60 (range 2.82–65.15). Antibody levels were found to have a statistically significant (p-value 0.019) negative correlation with the time since last administration of vaccine. A booster dose of Hepatitis B vaccine was administered to all non-responders, with each registering a statistically significant (p-value 0.00) anamnestic response. Conclusion: The vaccination schedule with short dosage interval was unable to provide protection to 42% of the study population. Introduction of birth dose of Hepatitis B vaccine to the existing schedule is recommended.Keywords: Primary Hepatitis B vaccination; Children; Immune response; Anamnestic immune response

Author Biographies

Muhammad Faheem Afzal, King Edward Medical University, Lahore

Assistant Professor, Department of Paediatrics, King Edward Medical University, Lahore

Muhammad Ashraf Sultan, King Edward Medical University, Lahore

Chairman/Professor, Department of Paediatrics, King Edward Medical University, Lahore

Ahmad Imran Saleemi, King Edward Medical University, Lahore

Post Graduate resident, Department of Paediatrics

References

Teoharov P, Kevorkyan A, Petrova N, Baltadzhiev I, Van Damme P. Immune Memory and Immune Response in Children From Bulgaria 5–15 Years After Primary Hepatitis B Vaccination. Pediatr Infect Dis J 2013;32(1):51–3.

Bosan A, Qureshi H, Bile KM, Ahmad I, Hafiz R. A review of hepatitis viral infection in Pakistan. J Pak Med Assoc 2010;60(12):1045–58.

Ali SA, Donahue RM, Qureshi H, Vermund SH. Hepatitis B and hepatitis C in Pakistan: prevalence and risk factors. Int J Infect Dis 2009:13(1):9–19.

WHO. Hepatitis B. World Health Organization. [Internet]. [cited 2014 Dec. 10]. Available from: http://www.who.int/mediacentre/factsheets/fs204/en/

WHO. Hepatitis B vaccines, WHO position paper. Weekly epidemiological record Releve epidemiologique hebdomadaire 2009;84:405. [Internet]. [cited 2014 Dec 10]. Available from: http://www.who.int/wer/2009/wer8440.pdf?ua=1

Al-Shamahy HA, Hanash SH, Rabbad IA, Al-Madhaji NM, Naser SM. Hepatitis B vaccine coverage and the immune response in children under ten years old in Sana’a, Yemen. Sultan Qaboos Univ Med J 2011;11(1):78–82.

Leuridan E, Van Damme P. Hepatitis B and the need for a booster dose. Clin Infect Dis 2011;53(1):68–75.

Centre for disease control and prevention. General recommendations on immunization recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep 2011;60(2):1–64.

WHO. Pakistan, Expanded Program for immunization. World Health Organization. [Internet]. [cited 2014 Dec 15]. Available from: http://www.emro.who.int/pak/programmes/expanded-programme-on-immunization.html

Capending MR, Cadorna-Carlos J, Book-Montellanoc M, Ortiz E. Immunogenicity and safety of a DTaP–IPV//PRP~T combination vaccine given with hepatitis B vaccine: a randomized open label trial. Bull World Health Organ 2008;86(6):443–51.

Fitzsimons D, François G, Hall A, McMahon B, Meheus A, Zanetti A, et al. Long-term efficacy of hepatitis B vaccine, booster policy, and impact of hepatitis B virus mutants. Vaccine 2005;23(32):4158–66.

Girisha KM, Kamat JR, Nataraj G. Immunological response to two hepatitis B vaccines administered in two different schedules. Indian J Pediatr 2006;73(6):489–91.

Jilg W, Schmidt M, Deinhardt F. Vaccination against hepatitis B: comparison of three different vaccination schedules. J Infect Dis 1989;160(5):766–9.

Halsey NA, Moulton LH, O’Donovan JC, Walcher JR, Thoms ML, Margolis HS, et al. Hepatitis B vaccine administered to children and adolescents at yearly intervals. Pediatrics 1999;103(6 Pt 1):1243–7.

WHO. Summary of WHO position papers-Recommendation for routine immunization. [Internet]. [cited 2016 Oct 2]. Available from: http://www.who.int/immunization/policy/Immunization_routine_table1.pdf?ua=1

Published

2016-11-27

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